KINGDOM CLEAN SERVICE REQUEST FORM

KINGDOM CLEAN SERVICE REQUEST FORM
Date*

MonthDayYear
Date
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Company Name (If not a company, type RESIDENTIAL)*
Phone Number*

Area CodePhone Number
Extension
Email*
example@example.com
Address where cleaning service is being completed if not the same as above:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
House/Property Dimensions (i.e. square footage)*
How did you hear about us?*
What size is your Driveway?*
If not getting driveway cleaned select N/A
Commerical & Residential Service Request Select One or more*

Garbage Bins/CansGarbage PadsDrivewayGutter CleaningPatio/Deck CleaningPool Screen CleaningExterior Building/Home Cleaning (i.e. Siding/Brick/etc.)Commercial Exterior Vehicle CleaningCurbside Cleaning/SidewalkFence CleaningEntrywayRoof wash (soft wash)Algae/rust/oil stainOther
Preferred Date and Time of Service*

MonthDayYear
DateHourMinutesAM/PM Option
Service Duration:*

RecurringOne time
Recurring Duration*
ATTN:

There is a non-refundable $50 deposit to secure your date of service.

Payment Options:

CASHAPP: KINGDOMSRV

ZELLE & PAYPAL: kingdomclean316@gmail.com

APPLEPAY: 773-499-6941

CREDIT OR DEBIT

CASH, CASHIERS CHECK, COMPANY CHECK OR MONEY ORDERS ACCEPTED

NOTE:

WE DO NOT ACCEPT PERSONAL CHECKS
Description/Instructions from Client (If none type N/A):*
Please upload photos of area being serviced and you will receive your quote:*

Browse Files

Cancelof
Signature*

Clear
Should be Empty: